26 November 2011


The anesthesiology resident who writes at the Asclepion blog has likened his work to that of Charon, the ancient Greek ferryman of the underworld:
I have wondered if anesthesiologists are similar (but distinctly different) mariners [to Charon].  We dare to cross that threshold with the faith that our trips are not one-way. We take those, coin in eye, who have some need of transient depth, who trust us as navigators and cartographers. Are patients the modern day Heracles and Orpheus? Do we carry them across some mythical river and return them safely from their katabasis?
An experience in clinic had made me compare my work to Charon's, but in an entirely different way. Given the wonderful ambiguity of some Greek myths, it's only fitting that we'd establish different connections to this same character.
My patient was an impoverished illegal immigrant with a shockingly low potassium level, so low as to be fatal for most people. His blood pressure was also quite elevated. The attending and I whittled down his differential diagnosis until it pointed strongly to primary hyperaldosteronism, an oversecretion of a particular hormone that is often caused by a tumor. We scheduled him for a more extensive work-up.

And yet, beyond treating symptoms, there would probably be little our free clinic could do. We lacked the capacity to perform CT's, MRI's, X-rays, or ultrasounds, any of which we would need to find a tumor. If the presence of a tumor were confirmed, our patient would not be able to afford the life-saving surgery. As an illegal immigrant, he lacked insurance and was ineligible for county services. He could only be admitted to our university hospital if he became so ill that it would be illegal for the ER to discharge him. Entirely because he could not access care, his prognosis looked grim.

Here, I felt like Charon, who ferries people to the underworld. Our laws and medical system prevented us from healing this human being. All I could do was briefly and helplessly accompany him as he traveled to the other side.

Last year, Congress shot down a proposal that would have allowed tax-paying illegal immigrants to purchase health insurance. It's fortunate for our legislators that they don't have to witness the consequences firsthand.

On a happier note, children under 18 are insured by the state and federal government, regardless of immigration status. I haven't seen any in clinic, and that's the way it should be.